Choosing Wisely:

Don’t image for suspected pulmonary embolism (PE) without moderate or high pretest probability.

While deep venous thrombosis (DVT) and PE are relatively common clinically, they are rare in the absence of elevated blood D-dimer levels and certain specific risk factors. Imaging, particularly CT pulmonary angiography, is a rapid, accurate, and widely available test, but has limited value in patients who are very unlikely, based on serum and clinical criteria, to have significant value. Imaging is helpful to confirm or exclude PE only for such patients, not for patients with low pretest probability of PE.